Last name:    First name:    Initial:

                                      Street address:

                                      City & State:    Zip code:

                                      Home phone (area code first, including hyphens):

                                      Social Security number (including hyphens):     

                                      Click on your age group:

                                  0 - 12 years

                                  13 - 16 years

                                      I would like to be notified of reserves and overdue items by:

                                  Phone

                                  E-Mail

                                      What type of library card would you prefer?:

                                  Wallet card

                                  Keychain card

                                      I wish to pick up my card at:  (choose one)

                                  James City County Library, 7770 Croaker Road

                                  Williamsburg Library, 515 Scotland Street

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Parent/Guardian Information

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Last name:    First name:    Initial:

 

Statement of Responsibility

I want my child to borrow Library materials from the Williamsburg Regional Library. I will be responsible for all materials borrowed on my child's card. I agree to pay any charges imposed for late return, damage, or loss of Library materials. I understand the information on this form is confidential and will not be shared with any other institution.

Parent/Guardian Signature: ________________________________________________

 

Print this page.   Have a parent or guardian sign this form.   Click the "Submit" button below.   Bring the signed form to the library to get your card.